Faculty Bibliography
Searched for:
school:SOM
Department/Unit:Child and Adolescent Psychiatry
Total Results:
11295
Intranasal Oxytocin in Children and Adolescents with Autism Spectrum Disorder
BACKGROUND:Experimental studies and small clinical trials have suggested that treatment with intranasal oxytocin may reduce social impairment in persons with autism spectrum disorder. Oxytocin has been administered in clinical practice to many children with autism spectrum disorder. METHODS:We conducted a 24-week, placebo-controlled phase 2 trial of intranasal oxytocin therapy in children and adolescents 3 to 17 years of age with autism spectrum disorder. Participants were randomly assigned in a 1:1 ratio, with stratification according to age and verbal fluency, to receive oxytocin or placebo, administered intranasally, with a total target dose of 48 international units daily. The primary outcome was the least-squares mean change from baseline on the Aberrant Behavior Checklist modified Social Withdrawal subscale (ABC-mSW), which includes 13 items (scores range from 0 to 39, with higher scores indicating less social interaction). Secondary outcomes included two additional measures of social function and an abbreviated measure of IQ. RESULTS:Of the 355 children and adolescents who underwent screening, 290 were enrolled. A total of 146 participants were assigned to the oxytocin group and 144 to the placebo group; 139 and 138 participants, respectively, completed both the baseline and at least one postbaseline ABC-mSW assessments and were included in the modified intention-to-treat analyses. The least-squares mean change from baseline in the ABC-mSW score (primary outcome) was -3.7 in the oxytocin group and -3.5 in the placebo group (least-squares mean difference, -0.2; 95% confidence interval, -1.5 to 1.0; P = 0.61). Secondary outcomes generally did not differ between the trial groups. The incidence and severity of adverse events were similar in the two groups. CONCLUSIONS:This placebo-controlled trial of intranasal oxytocin therapy in children and adolescents with autism spectrum disorder showed no significant between-group differences in the least-squares mean change from baseline on measures of social or cognitive functioning over a period of 24 weeks. (Funded by the National Institute of Child Health and Human Development; SOARS-B ClinicalTrials.gov number, NCT01944046.).
PMID: 34644471
ISSN: 1533-4406
CID: 5340542
Headache in ADHD as comorbidity and a side effect of medications: a systematic review and meta-analysis
There is mixed evidence on the association between headache and attention-deficit/hyperactivity disorder (ADHD), as well as headache and ADHD medications. This systematic review and meta-analysis investigated the co-occurrence of headache in children with ADHD, and the effects of ADHD medications on headache. Embase, Medline and PsycInfo were searched for population-based and clinical studies comparing the prevalence of headache in ADHD and controls through January 26, 2021. In addition, we updated the search of a previous systematic review and network meta-analysis of double-blind randomized controlled trials (RCTs) on ADHD medications on June 16, 2020. Trials of amphetamines, atomoxetine, bupropion, clonidine, guanfacine, methylphenidate, and modafinil with a placebo arm and reporting data on headache as an adverse event, were included. Thirteen epidemiological studies and 58 clinical trials were eligible for inclusion. In epidemiological studies, a significant association between headache and ADHD was found [odds ratio (OR) = 2.01, 95% confidence interval (CI) = 1.63-2.46], which remained significant when limited to studies reporting ORs adjusted for possible confounders. The pooled prevalence of headaches in children with ADHD was 26.6%. In RCTs, three ADHD medications were associated with increased headache during treatment periods, compared to placebo: atomoxetine (OR = 1.29, 95% CI = 1.06-1.56), guanfacine (OR = 1.43, 95% CI = 1.12-1.82), and methylphenidate (OR = 1.33, 95% CI = 1.09-1.63). The summarized evidence suggests that headache is common in children with ADHD, both as part of the clinical presentation as such and as a side effect of some standard medications. Monitoring and clinical management strategies of headache in ADHD, in general, and during pharmacological treatment are recommended.
PMID: 34635194
ISSN: 1469-8978
CID: 5091852
Physical and mental health impact of COVID-19 on children, adolescents, and their families: The Collaborative Outcomes study on Health and Functioning during Infection Times - Children and Adolescents (COH-FIT-C&A)
BACKGROUND:The COVID-19 pandemic has altered daily routines and family functioning, led to closing schools, and dramatically limited social interactions worldwide. Measuring its impact on mental health of vulnerable children and adolescents is crucial. METHODS:The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT - www.coh-fit.com) is an on-line anonymous survey, available in 30 languages, involving >230 investigators from 49 countries supported by national/international professional associations. COH-FIT has thee waves (until the pandemic is declared over by the WHO, and 6-18 months plus 24-36 months after its end). In addition to adults, COH-FIT also includes adolescents (age 14-17 years), and children (age 6-13 years), recruited via non-probability/snowball and representative sampling and assessed via self-rating and parental rating. Non-modifiable/modifiable risk factors/treatment targets to inform prevention/intervention programs to promote health and prevent mental and physical illness in children and adolescents will be generated by COH-FIT. Co-primary outcomes are changes in well-being (WHO-5) and a composite psychopathology P-Score. Multiple behavioral, family, coping strategy and service utilization factors are also assessed, including functioning and quality of life. RESULTS:Up to June 2021, over 13,000 children and adolescents from 59 countries have participated in the COH-FIT project, with representative samples from eleven countries. LIMITATIONS/CONCLUSIONS:Cross-sectional and anonymous design. CONCLUSIONS:Evidence generated by COH-FIT will provide an international estimate of the COVID-19 effect on children's, adolescents' and families', mental and physical health, well-being, functioning and quality of life, informing the formulation of present and future evidence-based interventions and policies to minimize adverse effects of the present and future pandemics on youth.
PMCID:8486586
PMID: 34606810
ISSN: 1573-2517
CID: 5099492
Internet use and its impact on internalizing disorder symptoms and sleep in adolescents with an evening circadian preference
STUDY OBJECTIVES:This study sought to examine the relationship between internet use, sleep, and internalizing disorder symptoms in adolescents with an evening circadian preference. METHODS:One hundred seventy-two adolescents aged 10-18 years with an evening circadian preference completed a week of sleep diaries and questionnaires about internet use and internalizing disorder symptoms. RESULTS:Adolescents reported internet use for 3.81 hours on weekdays and 5.44 hours on weekends, with > 90% having access to both a computer with internet and a personal cell phone. A majority of adolescents used the internet from 4-8 pm (71%) and from 9-11 pm (62%). Common online activities included listening to music (77%), watching videos (64%), communicating with others (64%), and doing homework (58%). Late-night internet use (9-11 pm) was associated with more internalizing disorder symptoms. Middle-of-the-night internet use (midnight-5 am) was associated with a later bedtime, shorter total sleep time, and more internalizing disorder symptoms. Adolescents used the internet to fulfill social needs, to avoid or combat boredom, or for maladaptive activities. Using the internet for social interaction or avoidance/boredom was associated with higher internalizing disorder symptoms. Using the internet for maladaptive reasons was associated with more late-night and middle-of-the-night use. CONCLUSIONS:Adolescent internet use late at night and in the middle of the night is common. Internet use may be motivated by desires for social connection, by boredom/avoidance, or for maladaptive behaviors. Because middle-of-the-night internet use was associated with higher internalizing disorder symptoms and worse sleep, it presents as a potential target for intervention. CITATION:2021;17(10):2019-2027.
PMCID:8494100
PMID: 34606439
ISSN: 1550-9397
CID: 5173562
Cortical and subcortical brain structure in generalized anxiety disorder: findings from 28 research sites in the ENIGMA-Anxiety Working Group
The goal of this study was to compare brain structure between individuals with generalized anxiety disorder (GAD) and healthy controls. Previous studies have generated inconsistent findings, possibly due to small sample sizes, or clinical/analytic heterogeneity. To address these concerns, we combined data from 28 research sites worldwide through the ENIGMA-Anxiety Working Group, using a single, pre-registered mega-analysis. Structural magnetic resonance imaging data from children and adults (5-90 years) were processed using FreeSurfer. The main analysis included the regional and vertex-wise cortical thickness, cortical surface area, and subcortical volume as dependent variables, and GAD, age, age-squared, sex, and their interactions as independent variables. Nuisance variables included IQ, years of education, medication use, comorbidities, and global brain measures. The main analysis (1020 individuals with GAD and 2999 healthy controls) included random slopes per site and random intercepts per scanner. A secondary analysis (1112 individuals with GAD and 3282 healthy controls) included fixed slopes and random intercepts per scanner with the same variables. The main analysis showed no effect of GAD on brain structure, nor interactions involving GAD, age, or sex. The secondary analysis showed increased volume in the right ventral diencephalon in male individuals with GAD compared to male healthy controls, whereas female individuals with GAD did not differ from female healthy controls. This mega-analysis combining worldwide data showed that differences in brain structure related to GAD are small, possibly reflecting heterogeneity or those structural alterations are not a major component of its pathophysiology.
PMCID:8486763
PMID: 34599145
ISSN: 2158-3188
CID: 5039482
Journal of the American Academy of Child and Adolescent Psychiatry. 2021:Conference:(68th):S64-S65.DOI: 10.1016/j.jaac.2021.07.275
GROWING UP DIFFERENT: THE IMPACT OF RACISM ON ADOLESCENT IDENTITY [Meeting Abstract]
Objectives: The United States is among the most diverse nations worldwide, boasting a majority percentage of the population comprised of ethnic minorities. Despite this, there remains a longstanding and pervasive history of racism toward several minority ethnic groups. According to a 2019 report from the Pew Research Center, race relations in America have worsened in recent times. Racism is a social determinant of health. Experiences of racism significantly impact the identity and self-perception of children and adolescents. It is therefore critical to examine how the unique racial experience of prominent ethnic minority groups shapes their developing identities and to accurately inform best practices in mental health diagnosis and treatment.
Method(s): Presenters will review the historical context of racism in the United States for the following prominent minority groups: African American, Latinx, East Asian, and South Asian. Each presenter will expand on the experience of racism specific to each ethnic group, identify unique negative biases, and review how these dynamics of discrimination impact adolescent identity development. Presenters will also share clinical pearls for how to explore topics of racial discrimination with youth in treatment.
Result(s): The experience of racism in adolescence has a significant impact on the developing adolescent identity and increases the risk of poor self-esteem, social isolation, and mental illness.
Conclusion(s): Racism is an unquestionably prevalent social issue affecting Americans of varying ethnic backgrounds. The experience of racism can be unique for differing ethnic groups. Because racism has a significant impact on the identity of developing youth and can increase the risks of mental illness, it is imperative for psychiatrists to consider race and ethnic bias in our discussions, assessments, and treatment of our patients. ETHN, ADOL, IDD
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Method(s): Presenters will review the historical context of racism in the United States for the following prominent minority groups: African American, Latinx, East Asian, and South Asian. Each presenter will expand on the experience of racism specific to each ethnic group, identify unique negative biases, and review how these dynamics of discrimination impact adolescent identity development. Presenters will also share clinical pearls for how to explore topics of racial discrimination with youth in treatment.
Result(s): The experience of racism in adolescence has a significant impact on the developing adolescent identity and increases the risk of poor self-esteem, social isolation, and mental illness.
Conclusion(s): Racism is an unquestionably prevalent social issue affecting Americans of varying ethnic backgrounds. The experience of racism can be unique for differing ethnic groups. Because racism has a significant impact on the identity of developing youth and can increase the risks of mental illness, it is imperative for psychiatrists to consider race and ethnic bias in our discussions, assessments, and treatment of our patients. ETHN, ADOL, IDD
Copyright
EMBASE:2014994529
ISSN: 1527-5418
CID: 5024322
Journal of child psychology & psychiatry & allied disciplines. 2021:62(10):1202-1219.DOI: 10.1111/jcpp.13396
Analysis of structural brain asymmetries in attention-deficit/hyperactivity disorder in 39 datasets
OBJECTIVE:Some studies have suggested alterations of structural brain asymmetry in attention-deficit/hyperactivity disorder (ADHD), but findings have been contradictory and based on small samples. Here, we performed the largest ever analysis of brain left-right asymmetry in ADHD, using 39 datasets of the ENIGMA consortium. METHODS:We analyzed asymmetry of subcortical and cerebral cortical structures in up to 1,933 people with ADHD and 1,829 unaffected controls. Asymmetry Indexes (AIs) were calculated per participant for each bilaterally paired measure, and linear mixed effects modeling was applied separately in children, adolescents, adults, and the total sample, to test exhaustively for potential associations of ADHD with structural brain asymmetries. RESULTS:There was no evidence for altered caudate nucleus asymmetry in ADHD, in contrast to prior literature. In children, there was less rightward asymmetry of the total hemispheric surface area compared to controls (t = 2.1, p = .04). Lower rightward asymmetry of medial orbitofrontal cortex surface area in ADHD (t = 2.7, p = .01) was similar to a recent finding for autism spectrum disorder. There were also some differences in cortical thickness asymmetry across age groups. In adults with ADHD, globus pallidus asymmetry was altered compared to those without ADHD. However, all effects were small (Cohen's d from -0.18 to 0.18) and would not survive study-wide correction for multiple testing. CONCLUSION/CONCLUSIONS:Prior studies of altered structural brain asymmetry in ADHD were likely underpowered to detect the small effects reported here. Altered structural asymmetry is unlikely to provide a useful biomarker for ADHD, but may provide neurobiological insights into the trait.
PMID: 33748971
ISSN: 1469-7610
CID: 4822272
Journal of the American Academy of Child and Adolescent Psychiatry. 2021:Conference:(68th):S327-S328.DOI: 10.1016/j.jaac.2021.07.801
HOW TO GET PUBLISHED: TIPS, STRATEGIES, AND CONSULTATION FROM JAACAP AND JAACAP CONNECT [Meeting Abstract]
Objectives: Participants in this Workshop will learn methods by which to overcome common pitfalls and obstacles to scholarly writing and publication and will establish skills essential to getting papers published. Relatively few students, trainees, and clinicians publish scientific or other educational manuscripts because of limitations of time, experience, and access to mentorship. However, facilitating publishing opportunities for these groups is important because the process of authoring and publishing scientific manuscripts can increase competency in research literacy, engagement in evidence-based practices, and other skills needed to increase mastery in child and adolescent psychiatry.
Method(s): We provide attendees a "backstage pass" experience, combining practical instruction with individualized, hands-on training and consultation to build an early foundation for getting published. Topics covered include how to choose a publishable topic of interest and how to utilize and maintain mentorship relationships. Attendees also will receive personalized consultation and mentorship around their individual goals and their works in progress from peers and our presenters, who have significant and diverse experiences with authorship and publication-particularly with JAACAP and JAACAP Connect.
Result(s): Attendees will learn practical steps toward getting published in scholarly journals and strategies to overcome current limitations and obstacles. Participants also will have the opportunity to get started with mentored authorship and publishing experiences available through JAACAP Connect.
Conclusion(s): This Workshop provides medical students, residents, fellows, early-career psychiatrists, and other clinicians with limited scholarly experience both practical knowledge and foundational skills essential to writing and getting published. AC, ADV, R
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Method(s): We provide attendees a "backstage pass" experience, combining practical instruction with individualized, hands-on training and consultation to build an early foundation for getting published. Topics covered include how to choose a publishable topic of interest and how to utilize and maintain mentorship relationships. Attendees also will receive personalized consultation and mentorship around their individual goals and their works in progress from peers and our presenters, who have significant and diverse experiences with authorship and publication-particularly with JAACAP and JAACAP Connect.
Result(s): Attendees will learn practical steps toward getting published in scholarly journals and strategies to overcome current limitations and obstacles. Participants also will have the opportunity to get started with mentored authorship and publishing experiences available through JAACAP Connect.
Conclusion(s): This Workshop provides medical students, residents, fellows, early-career psychiatrists, and other clinicians with limited scholarly experience both practical knowledge and foundational skills essential to writing and getting published. AC, ADV, R
Copyright
EMBASE:2014993247
ISSN: 1527-5418
CID: 5024342
Journal of the American Academy of Child and Adolescent Psychiatry. 2021:Conference:(68th).DOI: 10.1016/j.jaac.2021.07.276
44.1 THE EXPERIENCE OF BLACK YOUTH IN THE UNITED STATES [Meeting Abstract]
Objectives: The history of racial discrimination against African American (AfAm) and Black people in the United States is deeply rooted in the history of this country. This presentation will help participants understand the intersection between racism, structural racism, and subsequent hardships as it relates to the AfAm youth's experience of discrimination. This presentation will also help participants learn practical approaches for exploring issues of discrimination with AfAm patients.
Method(s): The presenter will review the history of racial discrimination toward AfAm groups in the United States and give an overview of common experiences of discrimination for AfAm youth. Additionally, using the models of adolescent development of Erik Erikson, William Cross, James Marcia, and Beverly Tatum, the presenter will describe how racial prejudice impacts adolescent socialization and (racial) identity development, and the risk that this may confer for mental illness. Finally, the presenter will offer clinical pearls for clinicians to explore topics of racial and religious prejudice with AfAm patients.
Result(s): For AfAms, racism, segregation, and the resultant impacts on self-esteem and identity have been a constant reality and threat from the time of slavery through the present day. These brutal institutions, sanctioned and maintained by institutional racism, clearly manifest in all aspects of life for African Americans-segregated and unequal education system and housing, healthcare disparities, mental healthcare disparities, disproportionally elevated incarceration rates, and as painfully highlighted this past year, continued vulnerability to acts of violence at the hands of law enforcement. These disastrous long-term consequences have been documented and are clear. However, the experience of Black youth, introduced to these harsh realities over time, has strong implications during crucial periods of development, including physical, emotional, and identity development.
Conclusion(s): There is benefit for clinicians to incorporate exploration of the impact of racial discrimination, although it is challenging, in the evaluation and treatment of AfAm and Black youth. DEI, DEV, ADOL
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Method(s): The presenter will review the history of racial discrimination toward AfAm groups in the United States and give an overview of common experiences of discrimination for AfAm youth. Additionally, using the models of adolescent development of Erik Erikson, William Cross, James Marcia, and Beverly Tatum, the presenter will describe how racial prejudice impacts adolescent socialization and (racial) identity development, and the risk that this may confer for mental illness. Finally, the presenter will offer clinical pearls for clinicians to explore topics of racial and religious prejudice with AfAm patients.
Result(s): For AfAms, racism, segregation, and the resultant impacts on self-esteem and identity have been a constant reality and threat from the time of slavery through the present day. These brutal institutions, sanctioned and maintained by institutional racism, clearly manifest in all aspects of life for African Americans-segregated and unequal education system and housing, healthcare disparities, mental healthcare disparities, disproportionally elevated incarceration rates, and as painfully highlighted this past year, continued vulnerability to acts of violence at the hands of law enforcement. These disastrous long-term consequences have been documented and are clear. However, the experience of Black youth, introduced to these harsh realities over time, has strong implications during crucial periods of development, including physical, emotional, and identity development.
Conclusion(s): There is benefit for clinicians to incorporate exploration of the impact of racial discrimination, although it is challenging, in the evaluation and treatment of AfAm and Black youth. DEI, DEV, ADOL
Copyright
EMBASE:2014994845
ISSN: 1527-5418
CID: 5024302
Symptoms and Characteristics of Youth Hospitalized for Depression: Subthreshold Manic Symptoms Can Help Differentiate Bipolar from Unipolar Depression
PMID: 34637626
ISSN: 1557-8992
CID: 5323432
